2020-11-09T09:29:25-06:00 2019-12-31 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2019-01-01 222495808 Fanny Allen Corporation FANN 9786546363 100 Ames Pond Drive No 102 Tewksbury MA 01876 Stephen W Forney SVP/CFO 9786546363 2020-11-02 1 Nicholas E Porto P01310283 2078792100 2020-11-02 208.105.168.164 2020-11-02 15:20:43 ES P 38659DA796957EF4727498C6F5EA77981E0D27E4 DA1D1F22D002DE74304CAE64996AD19EA354FE22 2019 2021-01-29 14:40:06Z Fanny Allen Foundation Christine Werneke 100 Ames Pond Drive No 102 Tewksbury MA 01876 685487 0 X www.fannyallen.org/ X 1983 VT To provide grants to other not-for-profits in Vermont that serve the poor and needy. 10 8 0 8 0 0 200000 0 0 0 173020 685487 0 0 373020 685487 288000 305658 0 0 0 0 0 0 0 242 759 288242 306417 84778 379070 8787697 10189092 0 1667 8787697 10187425 The Fanny Allen Corporation provides support and grants to other not-for-profit organizations in Vermont that serve the poor and the most needy. 0 0 306417 305658 0 The Fanny Allen Corporation provides support and grants to other not-for-profit organizations in Vermont that serve the poor and the most needy. 306417 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 0 0 0 0 X X Stephen W Forney Treasurer SVPCFO 9786546363 100 Ames Pond Drive No 102 Tewksbury MA 01876 Stephen Grubbs Director 1.00 43.00 X 0 712592 31007 Stephen W Forney Chair, Treasurer, SVP/CFO 3.00 42.00 X X 0 155201 7108 Jennifer Archambault Director 1.00 0.00 X 0 0 0 Thomas Barritt Director 1.00 0.00 X 0 0 0 Tracy Huntington Director 1.00 0.00 X 0 0 0 Ellen Kane Director 1.00 0.00 X 0 0 0 Peter Moino Director 1.00 0.00 X 0 0 0 Maureen O'Reilly Director 1.00 0.00 X 0 0 0 Christine Werneke Director 3.00 1.00 X X 0 0 0 Heidi St Peter Secretary 1.00 0.00 X X 0 0 0 0 867793 38115 0 0 1 1 0 685487 685487 685487 0 0 685487 305658 305658 759 759 306417 306417 0 0 195787 166956 6601622 8400353 1990288 1621783 8787697 10189092 0 1667 0 1667 X 6843681 8243409 1944016 1944016 8787697 10187425 8787697 10189092 X 379070 820658 200000 X X 0 1 X 1 0 X X 1 Covenant Health Inc 222484505 10 1 0 0 1 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 Form 990, Schedule A, Part IV, Section A, Line 6: The Organization makes grants to certain unrelated organizations consistent with the mission of Covenant Health Inc., which is to provide health and human services-assistance in the manner consistent with the Healing Ministry of Jesus Christ in the Roman Catholic Church. The Organization was organized to operate exclusively for the benefit of, to perform the functions of, or to carry out the purposes of Covenant Health, Inc., other organizations within or affiliated with the Covenant Health System that are exempt as 501(c)(3) public charities under Section 501(a)(1) or 509(a)(2), and/or other organizations that are exempt as 501(c)(3) public charities under Section 501(a)(1) or 509(a)(2). But for the existence of Fanny Allen Corporation, Covenant Health, Inc. would be responsible for making grants to the Organizations provided grants by Fanny Allen Corporation. 1944016 1944016 1944016 1944016 1944016 1944016 1944016 1944016 1944016 1944016 0.00000 0.29920 0.70080 1 0 0 Investment in Providentia Prima Trust 8400353 F 8400353 Split interest restricted funds 1621783 1621783 X Part X, Line 2: Covenant and its member organizations are considered not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code, except as noted below. Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. Under guidance issued by the Financial Accounting Standards Board, assets and liabilities are established for uncertain tax positions taken or positions expected to be taken in income tax returns when such positions are judged to not meet the "more-likely-than-not" threshold, based upon the technical merits of the position. Estimated interest and penalties, if applicable, related to uncertain tax positions are included as a component of income tax expense. The System has evaluated the position taken on its filed tax returns. The System has concluded no uncertain income tax positions exist at December 31, 2019. 1 Vermont Catholic Charities Inc 55 Joy Drive South Burlington VT 05403 030181216 501(c)(3) 20000 General program support Faith In Action Northern Communities Partnership PO Box 157 Cabot VT 05647 208406050 501(c)(3) 15000 General program support Community Health Center of Burlington 617 Riverside Avenue Burlington VT 05401 237182584 501(c)(3) 13750 General program support Open Door Clinic 100 Porter Drive Middlebury VT 05753 030359531 501(c)(3) 13000 Community Health Services of Addison County Charter House Coalition PO Box 344 E Middlebury VT 05740 562531802 501(c)(3) 12126 General program support Samaritan House 24 Kingman Street Saint Albans VT 05478 030330331 501(c)(3) 12000 General program support Sara M Holbrook Community Center PO Box 3039 Burlington VT 05408 030179595 501(c)(3) 10000 General program support Camp Agape Vermont PO Box 8283 Essex VT 05451 263990854 501(c)(3) 10000 General program support Addison County Community Action Group (dba HOPE) 282 Broadman Street Suite 1A Middlebury VT 05753 237393720 501(c)(3) 10000 General program support John W Graham Emergency Shelter Service Inc 69 Main Street Vergennes VT 05491 032575219 501(c)(3) 10000 General program support Joint Urban Ministry Project (aka JUMP) 38 South Winooski Avenue Burlington VT 05401 202055113 501(c)(3) 10000 General program support The Janet S Munt Family Room 20 Allen Street Burlington VT 05401 815449524 501(c)(3) 10000 General program support Spectrum Inc (aka Spectrum Youth & Family Services) 31 Elmwood Avenue Burlington VT 05401 030253232 501(c)(3) 10000 General program support Vermont FoodBank 33 Parker Road Barre VT 05641 223021942 501(c)(3) 10000 General program support Upper Valley Haven Inc 713 Hartford Avenue White River Junction VT 05001 030277908 501(c)(3) 10000 General program support ANEW PLACE Inc PO Box 1481 Burlington VT 05402 030287599 501(c)(3) 10000 General program support Dismas of Vermont 103 East Allen Street Winooski VT 05404 030369442 501(c)(3) 10500 Burlington Dismas House Lund Family Center Inc PO Box 4009 Burlington VT 05406 030179434 501(c)(3) 9500 General program support Pathways Vermont 125 College Street 2nd Floor Burlington VT 05401 300604758 501(c)(3) 9500 General program support Boys & Girls Club of Burlington 62 Oak Street Burlington VT 05401 030179307 501(c)(3) 9250 General program support Martha's Kitchen PO Box 1561 St Albans VT 05478 030290790 501(c)(3) 8000 General program support Burlington Children's Space 241 N Winooski Avenue Burlington VT 05401 222533646 501(c)(3) 7500 General program support Green Mountain Habitat for Humanity 300 Cornerstone Drive Suite 335 Willston VT 05495 222558923 501(c)(3) 7500 General program support Greater Burlington YMCA Inc 298 College Street Burlington VT 05401 030185810 501(c)(3) 7500 General program support Our Community Cares Camp PO Box 503 Richmond VT 05477 264398448 501(c)(3) 7500 General program support Vermont Youth Conservation Corps Inc 1949 East Main Street Richmond VT 05477 030328834 501(c)(3) 7500 General program support Camp Exclamation Point Inc PO Box 91 Richmond VT 05477 030329568 501(c)(3) 6000 General program support Vermonts Camp Ta-Kum-Ta PO Box 459 South Hero VT 05486 030362578 501(c)(3) 5000 General program support University of Vermont Medical Center 111 Colchester Avenue Burlington VT 05401 030219309 501(c)(3) 5000 Fletcher Allen Health Care, LeRoyrer Employee Assistance Fund Prevent Child Abuse - Vermont (aka PCAVT) PO Box 829 Montpelier VT 05601 030267183 501(c)(3) 5000 General program support Champlain Valley Office of Economic Opportunity PO Box 1603 Burlington VT 05402 030216837 501(c)(3) 10000 General program support Vermont Works for Women 32A Mallets Bay Avenue Winooski VT 05404 222894557 501(c)(3) 4000 General program support 32 0 Part I, Line 2: Representatives of Fanny Allen Corporation interview potential grantee organizations that are seeking donations from the Corporation prior to issuing any grants. The Corporation also monitors the grantee organization by receiving and reviewing outcome reports from each grantee in order to ensure all grants and awards are properly utilized and accounted for. 0 1 0 0 0 0 0 0 0 Stephen Grubbs Director 0 691522 0 0 0 21070 0 2800 0 28207 0 743599 0 0 Stephen W Forney Chair, Treasurer, SVP/CFO 0 154719 0 0 0 482 0 0 0 7108 0 162309 0 0 Part I, Line 3 Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. Part I, Line 4b Covenant Health, Inc., a related organization and sole member of Fanny Allen Corporation, maintains a supplemental executive retirement program for certain executives under which the related organization makes a contribution for the benefit of its executive that is intended to provide a specified level of retirement benefits at a retirement age that is commensurate with the retirement benefits provided to other executives in comparable positions with similarly situated organizations. Amounts contributed to the program are held for the benefit of the executive until he or she reaches age 60, at which time the benefits are released to the executive. The full amount is taxable to the executive when so paid, and is included in the executive's reportable compensation. Mr. Stephen Grubbs participated in this program during the tax year and $19,000 has been included in Schedule J, Part II, Column B(iii) relative to this program. Form 990, Part VI, Section A, line 6 Covenant Health, Inc. is the sole corporate member of the Organization. Form 990, Part VI, Section A, line 7a As the sole corporate member of the Organization, Covenant Health, Inc. retains the ability to elect and remove the Organization's board of directors with or without cause. Form 990, Part VI, Section A, line 7b As the sole corporate member of the Organization, Covenant Health, Inc. has the following powers and rights over the Organization and its subsidiaries as outlined in the Organization's bylaws: 1. To approve any change in the written statements of philosophy and mission; 2. To amend and to repeal the organizing and governing documents; 3. To elect the Board of Directors or remove them with or without cause; 4. To appoint and remove the president; 5. To ratify the Board of Director's election of the Chair of the Board; 6. To approve all plans of merger, consolidation, reorganization, dissolution, or the sale, lease assignment, or transfer of substantially all of the assets, or the purchase or acquisition of an interest in any corporation, partnership, joint venture, or other entity; 7. To approve all long-range strategic plans before implementation; 8. To approve the acquisition, sale, or encumberance of any real estate valued in excess of an amount set by the Member in writing; 9. To approve all capital budgets and non-budgeted expeness in excess of an amount set by the Member in writing; 10. To approve all debt in excess of limits set by the Member in writing; 11. To appoint the auditors; 12. To approve the sale, assignment, or transfer of any equity interest or membership interest in any subsidiary; 13. To approve any reclassification or other change of any capital stock or other equity security; and, 14. To approve the issuance of, or the creation of any obligation to issue, any equity security. Form 990, Part VI, Section B, line 11b The Form 990 is provided to the governing body for their review and approval prior to filing. Form 990, Part VI, Section B, line 12c This process is the responsibility of the Compliance Officer. A conflict of interest disclosure form is submitted to all leadership, board members, board committee members, employed physicians, medical directors and certain employees in key positions annually to be completed. Reminders are sent to all persons of interest to ensure that all conflict of interest disclosure forms are completed and collected. Form 990, Part VI, Section B, line 15 Any compensation paid to the trustees, directors, officers or key employees of the Organization is subject to the oversight and decisions of Covenant Health, a related tax-exempt organization. Every two-to-three years the Compensation Committee of the Covenant Health Board of Directors engages an external consultant to provide competitive market data from various survey sources, which is then used to develop recommendations for changes to the compensation program. Since 2003, the Compensation Committee has engaged a human resources consultant to conduct this analysis. Objectives of the analysis are to assess the compositeness of the total cash compensation levels of the senior leadership team, develop market based competitive salary ranges for all executive positions, and ensure that the annual incentive opportunities, if there are any, are competitive and reasonable. Form 990, Part VI, Section C, line 19 The Organization's Form 990, governing documents, conflict of interest policy, and financial statements are made available to the public upon request. The Organization's Form 990 is also made available on the website of its parent organization, Covenant Health, at the following web address: https://www.covenanthealth.net/financial-information/financial-information Form 990, Part XI, line 9: Transfers from affiliates 200,000. Form 990, Part XII, Line 2c: The audit process has not changed from the previous year. Youville Lifecare Inc 1575 Cambridge Street Cambridge MA 02138 042103582 Hospital and health care facility MA 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph Manor Health Care 215 Thatcher Street Brockton MA 02302 042565937 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 St Mary's Health System PO Box 7291 Lewiston ME 04243 222504349 Hospital and health care facility ME 501(c)(3) Line 12a, I Covenant Health Inc 0 St Joseph's Hospital of Nashua NH Inc 172 Kinsley Street Nashua NH 03061 020222215 Hospital and health care facility NH 501(c)(3) Line 3 Covenant Health Inc 0 Youville Place 10 Pelham Road Lexington MA 02421 043297834 Assisted living services MA 501(c)(3) Line 10 Covenant Health Inc 0 St Mary's Villa Nursing Home Inc 675 St Marys Villa Road Moscow PA 18444 232057177 Nursing home and restorative facility PA 501(c)(3) Line 10 Covenant Health Inc 0 CHS of Waltham Inc dba Maristhill Nursing & Rehab Center 66 Newton Street Waltham MA 02453 043333609 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 CHS of Worcester Inc dba St Mary Care Center 39 Queen Street Worchester MA 01610 043419625 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 Fanny Allen Holdings Inc 790 College Parkway Colchester VT 05446 030181052 Real estate holding company VT 501(c)(3) Line 12a, I Covenant Health Inc 0 St Andre Health Care 407 Pool Street Biddeford ME 04005 010342399 Nursing home and restorative facility ME 501(c)(3) Line 10 Covenant Health Inc 0 MI Nursing Restorative Center Inc 172 Lawrence Street Lawrence MA 01841 042104851 Nursing home and restorative facility MA 501(c)(3) Line 10 Covenant Health Inc 0 Helping Hands of St Marguerite Inc 799 Concord Avenue Cambridge MA 02138 800199674 Private home-care health services MA 501(c)(3) Line 10 Covenant Health Inc 0 Providentia Prima Trust 420 Bedford Street Lexington MA 02420 046835128 Investment trust MA 501(c)(3) Line 12a, I Covenant Health Inc 0 Youville House Inc 1573 Cambridge Street Cambridge MA 02138 043239593 Assisted living services MA 501(c)(3) Line 10 Youville Lifecare Inc 0 Youville Hospital and Rehabilitation Center Inc 1575 Cambridge Street Cambridge MA 02138 043239563 Hospital and health care facility MA 501(c)(3) Line 10 Youville Lifecare Inc 0 St Mary's Regional Medical Center PO Box 7291 Lewiston ME 04243 010211551 Hospital and health care facility ME 501(c)(3) Line 3 St Mary's Health System 0 Community Clinical Services PO Box 7291 Lewiston ME 04243 010409788 Physician practice ME 501(c)(3) Line 10 St Mary's Health System 0 St Mary's D'Youville Pavilion PO Box 7291 Lewiston ME 04243 010211558 Nursing home and restorative facility ME 501(c)(3) Line 10 St Mary's Health System 0 St Mary's Residences PO Box 7291 Lewiston ME 04243 222504356 Low income housing ME 501(c)(3) Line 10 St Mary's Health System 0 Neighborhood Housing Initiative PO Box 7291 Lewiston ME 04243 010539730 Affordable housing services ME 501(c)(3) Line 10 St Mary's Health System 0 Souhegan Nursing Association 24 North River Road Milford NH 03055 020222795 Home health and hospice NH 501(c)(3) Line 10 St Joseph Hospital of Nashua NH Inc 0 The Surgicenter at St Joseph Hospital Inc 172 Kinsley Street Nashua NH 03061 020222215 Healthcare and surgery center NH 501(c)(3) Line 10 St Joseph Hospital of Nashua NH Inc 0 MI Management Inc 172 Lawrence Street Lawrence MA 01841 042857794 Assisted living services MA 501(c)(3) Line 12a, I Covenant Health Inc 0 MI Adult Day Health Care Center Inc 189 Maple Street Lawrence MA 01841 042921888 Adult day care services MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Residential Community Inc 189 Maple Street Lawrence MA 01841 042647207 HUD low income housing MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Residential Community II Inc 189 Maple Street Lawrence MA 01841 042679954 HUD low income housing MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Residential Community III Inc 189 Maple Street Lawrence MA 01841 042186043 HUD low income housing MA 501(c)(3) Line 10 Covenant Health Inc 0 MI Transportation Inc 189 Maple Street Lawrence MA 01841 042921889 Elderly transportation services MA 501(c)(3) Line 10 Covenant Health Inc 0 Mary Immaculate Guild Inc 172 Lawrence Street Lawrence MA 01841 463073987 Supporting grants and donations MA 501(c)(3) Line 12a, I Covenant Health Inc 0 St Joseph Healthcare Foundation 360 Broadway Bangor ME 04402 222480149 Healthcare foundation ME 501(c)(3) Line 10 Covenant Health Inc 0 St Joseph Hospital 360 Broadway Bangor ME 04402 010212435 Hospital and health care facility ME 501(c)(3) Line 3 St Joseph Healthcare Foundation 0 M & J Company 360 Broadway Bangor ME 04402 222480150 Lease holding company ME 501(c)(2) St Joseph Healthcare Foundation 0 St Joseph Ambulatory Care Inc 360 Broadway Bangor ME 04402 222480373 Physician practice ME 501(c)(3) Line 10 St Joseph Healthcare Foundation 0 Alternative Health Services 360 Broadway Bangor ME 04402 010422885 Home health and hospice ME 501(c)(3) Line 10 St Joseph Healthcare Foundation 0 Mount St Rita Health Centre 15 Sumner Brown Road Cumberland RI 02864 050342330 Nursing home RI 501(c)(3) Line 10 Covenant Health Inc 0 Penacook Place Inc 150 Water Street Haverhill MA 01830 237090088 Nursing home MA 501(c)(3) Line 10 Covenant Health Inc 0 Covenant Health Inc 100 Ames Pond Drive Tewksbury MA 01876 222484505 Health care management and resource organization MA 501(c)(3) Line 10 N/A 0 Covenant Health Foundation Inc 100 Ames Pond Drive Tewksbury MA 01876 800199674 Charitable foundation MA 501(c)(3) Line 12a, I Covenant Health Inc 0 Covenant Health Insurance LTD PO Box 69 Grand Cayman CJ KY1-1102 043360127 Self-insurance company CJ N/A C 0 Campus Holding PO box 7291 Lewiston ME 04240 010406049 Holding company ME N/A C 0 St Joseph Corporate Services Inc 172 Kinsley Street Nashua NH 03060 020405197 Holding company NH N/A C 0 Strauss Incorporated 360 Broadway Bangor ME 04402 010391369 Repairs and transcriptions ME N/A C 0 GNM Corporation 172 Kinsley Street Nashua NH 03060 020400550 Real estate holding company NH N/A C 0 SJ Physicians Services 172 Kinsley Street Nashua NH 03060 020522234 Physician practice NH N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1